Congressional Republicans are edging toward an early 2026 decision point on whether to attempt another party-line bill on healthcare after Congress failed to extend enhanced Affordable Care Act subsidies set to expire Dec. 31, 2025.

The debate is sharpening as the 2026 midterm campaign season approaches and millions of people who buy coverage through the ACA marketplaces brace for higher premiums beginning Jan. 1. 

The pandemic-era boost to federal premium tax credits helped drive record enrollment in recent years, but lawmakers left Washington for the holidays without an agreement to keep the assistance in place.

Republican leaders and lawmakers have been split for months over the idea of a second reconciliation package, a budget process that allows legislation to pass the Senate with a simple majority and avoid a filibuster. 

Supporters describe it as a last chance to lock in conservative policy priorities ahead of the election. Skeptics argue the party's narrow margins and long-running divisions over health policy make another sweeping effort risky and potentially unworkable.

House Speaker Mike Johnson, R-La., has signaled openness to exploring another reconciliation push, particularly after conservatives complained that the House's recent health-focused bill was too narrow. 

Some Republicans have also privately discussed using tariff revenue to send cash to taxpayers as an offset for rising healthcare costs, according to unnamed people familiar with the talks who spoke with Politico.

But resistance remains firm among key Republicans who would have to write and advance any package. Rep. Jason Smith, R-Mo., the chair of the House Ways and Means Committee, said he doubts a second reconciliation bill could pass. 

Other committee leaders have raised similar concerns, citing procedural hurdles, intra-party disagreements and worries about politically difficult votes heading into the midterms.

The strongest advocates are the party's budget leaders. House Budget Committee Chair Jodey Arrington, R-Texas, has argued Republicans need to deliver on long-promised priorities, while Senate Budget Committee Chair Lindsey Graham, R-S.C., has pushed for a package that could blend health care with defense and immigration measures.

Moderate and politically vulnerable House Republicans are especially wary after casting tough votes earlier this year on a major bill that included Medicaid cuts. 

Rep. Mike Lawler, R-N.Y., bluntly dismissed the idea of another party-line push in a closed-door discussion, saying it would "never" happen, according to people familiar with the meeting.

Outside groups are pressing GOP leaders to keep the effort moving. The Republican Study Committee has discussed an affordability-focused approach that includes expanding health savings accounts and other tax-preferred options. 

Rep. August Pfluger, R-Texas, a member of the group's leadership, argued a second push would not have to fracture the conference. 

"I don't think it has to be divisive," Pfluger said.

Top leaders, however, have been careful not to make commitments. Senate Majority Leader John Thune, R-S.D., has described reconciliation as difficult even when Republicans agree on broad goals. 

House Majority Leader Steve Scalise, R-La., has said lawmakers are still testing whether there is enough consensus to attempt another party-line bill.

For now, Republicans face a deadline-driven political reality: enhanced ACA subsidies expire at year's end, and the next steps on healthcare are colliding with midterm messaging, internal divisions, and the limits of the budget rules that govern reconciliation.